A comparative study of adoloscents ’ perceived stress and health outcomes among adolescent mothers and their infants in Lesotho

Curationis 30(1): 15-25 Purpose The purpose of this study was to compare perceived stress in general, stress due to pregnancy, and post partum complications between a group of unmarried adolescent first-time mothers and a group of married adolescent first-time mothers. Never-pregnant adolescents served as a comparison group on perceived stress. Health outcomes of infants of the two groups of adolescent mothers were also compared on birth weight, nutritional status (weight gain) and immunization status.


Findings
Findings of this study revealed significant differences in perceived stress between both groups of adolescent mothers and the group of never pregnant adolescents (p < .0001).The Chaffe* test revealed that never pregnant adolescents had lowest levels of perceived stress than both groups o f adolescent mothers (p < .0001).Both groups of adolescent mothers had high levels o f stress due to pregnancy and the difference between the two groups was non-significant.No differences were observed between infant health outcomes of unmarried mothers and infants o f married mothers.The infants of both groups were generally healthy and the majority of them had appropriate type and doses of immunizations six weeks post birth.

Conclusion
Adolescent mothers in the low lands o f Lesotho perceive pregnancy to be a stressful event despite marriage.Therefore adolescents should be discourage from early childbirth.Policy makers need to come up with gender sensitive policies that will make it easier for girls who get pregnant to continue with their education, so that they may be productive and self-reliant.

Introduction
Pregnancy is a natural phenomenon that is embraced with joy if it is well planned.Yet, even under ideal conditions, it is a potential stressor.The pregnant mother has to meet her own needs as well as the needs o f her unborn infant (Seller, 2 003:1715).
P regnancy am ong adolescents is even more stressful as the adolescent is not yet ready to take full responsibility for another life.Because in most cases the pregnancy is not planned, it causes a lot o f stress on the adolescent (Mngadi, Thembi, Ransjo-Arvidson, & Ahlberg 2002:38).Her life suddenly changes.She has to cater for her own developmental needs and the needs o f her unborn infant (Seller, 2003(Seller, :1715)).Pregnancy is also an indication that such adolescents engaged in unprotected sex.This practice exposes such adolescents to HIV/AIDS with fatal consequences (World Bank, 2004:1).The families o f these adolescents are burdened with the responsibility o f supporting the adolescent and her infant physically, mentally and financially.The financial support becom es quite a challenge in the families that are already poor.In some cases the parents of the pregnant adolescents may be very angry with her and not give her the support she needs.In the majority of cases the boyfriend denies the pregnancy for fear of expulsion from school and jeopardizing his future (Motlomelo & Sebatane (1999: 22).
Traditionally, women in Lesotho as in other African counties play a submissive role in a relationship.They do not negotiate the use of condoms and end up with pregnancy, HIV infection and Sexually Transmitted Diseases (STDs) (Moon, Khumalo-Sakutukwa, Heiman, Mbizvo and Padia, 2002:19).Lesotho Planned Parenthood (2005:1) points out that women in Lesotho are considered as minors under both the customary and civil laws thus making it difficult for them to ex ercise th eir d ecision to use contraceptives.The boyfriends o f adolescent girls bully their girlfriends by dictating the terms of sex and often beating these girls.Yet, the latter rem ain in these abusive relationships for fear of further abuses by their partners (Wood, Maforah and Jewkes, 1998:233;Vundile, Maforah, Jew kes and Jordaan (2001:52).Adolescent pregnancy is only acceptable among married adolescent in Lesotho.Pregnancy among unmarried adolescents carries social stigma (Mturi & Moerane, 2001:259).These negative factors culminate in stress among the affected adolescents.Yet, very few studies have been done on stress in pregnant and parenting adolescents in Lesotho.

Background
A number o f factors seem to contribute to the high pregnancy rate in Lesotho.The main factors are poor economy, culture and educational system.Lesotho is a poor country heavily dependent on South Africa economically.About forty percent of the male labour force that work as migrant labourers mainly in the mines and quarries in South Africa are being retrenched on an on-going basis (Omole, 2003:2;UNICEF, 2003:1).This has resulted in a high unemployment rate, which is estimated at 45% (2000 statistics) (World Factbook, 2003:5).Unfortunately these labourers are compelled to return to Lesotho where job opportunities are very lim ited (O m ole, 2003:2).Consequently, they move from their villages to the main cities seeking em ploym ent, w hich is not alw ays available.Although the families of the m igrant labourers benefitted economically from the mines and other employing organizations, the migrant labour system also had some drawbacks.T his system w eakens the fam ily institution.Whether these men are in South Africa or job seeking in the major cities of Lesotho, they are not available to guide their children.It is contrary to Basotho culture for adults to discuss issues related to sex and sexuality with children.Discussing these issues is perceived as encouraging children to engage in sexual activity prematurely.Consequently, adolescents get information on sex and sexuality from their own friends who also have deficient knowledge of the subject (Yako, 2000:8).Basotho culture also encourages early marriages.Because parents get Lobola (the bride price) when their daughters marry, they encourage their daughters to marry early in life in order to augment the family income (UNICEF, 2003:1).Inaccessibility of high school education in terms of cost also contributes to early adolescen t pregnancy in Lesotho.Education is accessible to learners at primary school level.The parents of learners pay nominal fees in the primary schools.The government of Lesotho introduced the free prim ary school education in 2000 beginning with the first graders.This progresses annually so that by 2006 all the seven grades of primary education will be covered (UNICEF, 2003:1).After primary education, a number of adolescents face a problem of continuing with their education.On one hand their parents are too poor to afford school fees in the high schools, and on the other hand, they (the adolescents) are also too young and unskillful to acquire well paying jobs.Some of these adolescents opt for marriage while others engage in sexual relatio n s out o f frustration or material gain from older men (Okpani & Okpani, 2000: 40).While others engage in minimum paying jobs such as baby-sitting or domestic work.Adolescents in this latter group are also at the risk of engaging in sex with older men in order to augment their salaries.Very few studies have been done on adolescent pregnancy in Lesotho.Therefore, it is not clear what stresses pregnancy brings to the adolescent mother and the impact o f the pregnancy on the health of the adolescent and her infant.It is also not clear whether marital status makes any significant difference in the health of this group.The purpose o f this study was to determine the difference in stress among unmarried pregnant adolescents, married pregnant adolescents and single never pregnant adolescents.In addition it sought to determine the difference in post partum complications between the married and married mothers.Health outcomes of infants of the two groups of adolescent mothers were also compared on birth weight, nutritional status (weight gain) and immunization status.
Findings of the study presented in this paper will provide baseline data on psychological and physical health of 15 to 19 year old adolescents, and on the health status o f the infants o f these adolescents.In addition, it will potentially assist the nurses in planning health promotion programmes and contribute in the development of gender responsive policies for adolescents in Lesotho.

Research questions
This study attem pted to answer the following questions: 1 Is there a difference in stress among unmarried pregnant adolescents, married pregnant adolescent and single never pregnant adolescents? 2 Is there a difference in stress due to pregnancy between married and unmarried adolescent mothers?
Is there a difference in post partum complications between married and unmarried adolescent mothers? 4 Is there a difference in birth weight, nutritional status (weight gain) and immunization status between the infants of married and unmarried adolescent mothers?

Methodology Design
The design study was cross-sectional, comparative and descriptive.Because no studies had been done on the impact o f pregnancy on the health o f adolescents in Lesotho, an exploratory type of design, which compared two or more samples, was found to be more ap p ro p riate in p roviding more information on perceived stress and health outcomes among the adolescents and their infants (B urns & Grove, 1993:294).

Sample
A convenience sample of 64 parenting single adolescents and 64 parenting married adolescents were be selected from thee hospitals and two health centres (clinics) in the Health Service Areas (HSAs) of Maseru, Maluti (3) Leribe and Butha-buthe.A comparison group of 64 non-pregnant adolescents were recruited from a high school in the Mapoteng area.This school mostly served students in the Mapoteng town and the surrounding villages.Participants had to meet the following criteria to be included in the study: (1) between the ages of 15 and 19 at the time o f study, (2) sin g leton birth, (3) primiparity, (4) attendance o f the clinic visit 6 weeks post delivery at the time of study and, (6) ability to read and write Sesotho (local language) or English.Criteria for inclusion of never pregnant adolescents were: (1) not pregnant or parenting at the time of the study, (2) between ages o f 15 to 19 years.Criteria for exclusion from the study were: (1) hospitalization with a serious medical or surgical condition and, (2) severe mental disturbance.Alpha of 0.05, a power of 0.80, and a m edium effect size o f 0.25 w ere established for estimation of the sample size.Based on the Analysis of Variance (ANOVA and ANCOVA) tables, a sample of 54 adolescents per group were required for this study.However, the principal investigator over sam pled by 18%, making the sample 64 adolescents per group in order to make allowance for attrition and missing data (Cohen, 1988).

Setting
Lesotho is divided into 19 Health Service A reas (H SA ).The 18 HSAs are composed of a hospital and the health centers in the surrounding area (CopyWrite, 2000:3).The 19th HSA is made o f the Lesotho Flying Doctor Service that serves clinics in the remote mountainous areas (CopyWrite, 2000: 5).Each HSA is responsible for delivery of health care services in the area.The HSA hospital supervises all the health centers in the area irrespective o f ownership.Nine HAS hospitals belong to the Christian Health Association of Lesotho (CHAL), and the rest belong to the government (CopyWrite).This study was conducted in the low lands due to accessibility o f subjects and costs.Potential subjects were from both the rural areas and the urban areas.

Data Collection
The principal investigator trained two research assistants in data collection.These assistants were registered nurses and registered m idw ives that had experience in working in the maternal child health (MC'H) clinics.They were introduced to the different instruments and show n how to fill out these instrum ents.To test for inter-rater reliability, the principal investigator and the two research assistants interviewed 10 adolescents sim ultaneously, and completed questionnaires, reviewed 10 health booklets for variables of interest and completed relevant checklists.The principal investigator's codings and codings of each of the research assistants were com pared for agreem ents and disagreements.Topf (1986:254) indicates that there is consensus among behavioral scientists that an average agreement of "70% is necessary, 80% is adequate, and 90% , is good" .T here was 100% agreem ent betw een the prin cip al investigator and the research assistants.Data were collected six weeks post delivery at a routine postnatal clinic.This was done immediately following full explanation o f the study and signing of the consent form by the adolescents and by the m others o f those under age.Questionnaires were distributed before assessment o f the adolescents during the postnatal visits.The research team guided the adolescents by answering th eir q uestions and m aking any clarifications on the questionnaires.Data on m aternal outcom es and infant outcomes were obtained from patients' health booklets ("Bukana" in Sesotho; the local language) and from hospital records.The principal, teachers, and students in the high school were given the same explanation o f the study as pregnant adolescents.A letter explaining the study and a consent form was given to each of the potential participants to give to her parent.Each of these parents and the student w ere requested to sign the consent form.Data were collected three days later after school within the same time frame as parenting adolescents.

Protection of Human Subjects
The study was carried following the guidelines of the Case Western Reserve University Institutional Review Board and the (Lesotho) Ministry o f Health and Social Welfare research ethics committee.Participants' rights o f confidentiality and anonymity were respected and they were given the freedom to withdraw from the study at any point.

Instruments
The instrum ents that w ere used to measure data in this study are summarized in Table 1.These instrum ents were selected based on their reliability and validity, and use across cu ltu res, especially, their applicability in an African context.The principal investigator translated the instruments into Sesotho and tested the instruments for accuracy of the translation.These instruments were given to two people who were fluent in both languages to translate back into the English version.The group then checked if the m eaning rem ained unchanged.The procedure was repeated

Data Analysis
The analyses of data were performed using SPSS 9.0 software for windows.
The difference in perceived stress among three groups o f ad o lescen ts was determined using ANOVA.For this analysis, perceived stress was viewed as the dependent variable.
The difference in perceived stress (due to pregnancy) between the two groups of adolescents was determined using a ttest for independent sam ples.The differences in postpartum complications between these two groups of adolescent mothers were determined using Chisquare.At-test for independent samples was used to determine the differences in birth w eight, nutritional status and 18 Curationis M arch 2007 immunization status between the two groups of infants.

Description of the Adolescent Sample
The sample consisted of 192 adolescent.

Description of the Infant Sample
One hundred twenty eight infants of adolescent mothers participated in this study.Sixty-four infants belonged to unmarried adolescent mothers and 64 to married adolescent mothers.There were more males than females in the group of infants of unmarried mothers, (N = 35, 54.7% and, N= 29,45.3 % respectively).Fifty percent of the infants o f married adolescent women were female.The mean birth weight of infants of unmarried mothers was 2931.9 grams (SD =565.58), and ranged 1200 to 4100 grams.The mean birth weight of infants of married mothers was 3089.7 grams (SD = 517.6),and ranged 1700 to 4300 grams.The mean weight gain 6 weeks post birth for infants of unmarried mothers was 1663.4 grams (SD = 593.9),and 1794.7 grams (SD = 571.2) for infants of married adolescent mothers.The modes o f delivery of infants in both groups were similar.

Descriptions and analyses of perceived stress
Perceived stress was measured from two perspectives, hassles o f daily living and concerns o f pregnancy and delivery.Daily hassles were measured using the Daily Hassles Scale.Higher scores on this scale indicated higher levels o f hassles.Unmarried parenting mothers had the highest levels of perceived stress (Mean =75.44,SD = 25.51),followed by parenting married mothers, (Mean = 71.41,SD = 22.65), and single neverpregnant adolescents (Mean = 66.78,SD = 25.2).
A one-way ANOVA test of the means of three study groups was done to determine the difference in perceived stress as measured by the Daily Hassles Scale.ANOVA indicated significant differences in daily hassles among the three groups of adolescents (F (2, 189) = 15.32,P <. 0001).A Post Hoc test (Scheffe' test) was done to d eterm ine the differences in means among the three groups (Burns & Grove, 1993:515).Significant group differences were found between the never-pregnant adolescents and the tw o groups o f adolescent m others, w ith the n ever-pregnant adolescents having lowest perceived stress.The mean difference between the n ev er-p reg n an t ad o lescen ts and unmarried adolescents was -21.95, (p < .0001),and between the never pregnant adolescent and married adolescents was -17.92, (p < .000).The mean difference betw een unm arried and m arried adolescent mothers was small and non significant (-4.0, p < .64).
The feeling of Pregnancy Questionnaire was used to measure pregnancy stress.Higher scores on this measure indicated higher levels o f stress.Unm arried adolescent mothers had higher stress levels with a mean o f30.76, (SD = 31.27).Married parenting adolescent mothers had a mean of 128.64, (SD = 29.68).However, no significant between group differences in stress levels were found.Perceived stress due to pregnancy was measured using FOPQ.A t-test was done to determine the difference in means of the FOPQ scores between the unmarried and married adolescent mothers.The differences in mean scores between these two groups were not significant.Non significant results in maternal concerns were found.Subscales of the FOPQ were assessed to determine major sources of stress among adolescent mothers.Both groups of mothers were concerned more about themselves than the baby.Scores for the unmarried mothers and the married mothers on the FOPQ subscale concern for self were: mean = 30.47(SD = 8.50) and mean = 28.03(SD = 8.30) respectively, and on the FOPQ subscale concern for the baby were: mean = 25.12,(SD= 8.10) and mean = 25.40 (SD = 6.83) respectively.Non-significant differences between the unm arried and married adolescent m others were found on pregnancy concerns [t (1.92) = -.394,p < 0.75] on the FOPQ total scale.Similar results were found on all the subscales the FOPQ.These analyses indicate that pregnancy and parenting are stressful for the adolescent mothers irrespective of marital status.
In this study, postpartum complications were measured using the Postpartum Complication Checklist.The two groups of adolescent mothers in this sample had few complications.Only 1 (1.6%) married adolescent mother had 1 postpartum com plication which was postpartum hemorrhage.Approximately 19(29.7%)unm arried m others had postpartum complications; engorged breasts (N = 6, 9.3%), cracked nipples (N = 4, 6.3%), postpartum hemorrhage (N = 5, 9 7.8%), high blood pressure with sy sto lic pressures of more than 140 mm Hg (N = 2, 3.1%), infected episiotomy (N = 1, 1.6%), and urinary retention (N =1,1.6%).C hi-square analysis was used to determine differences in postpartum complications between unmarried and married adolescent mothers.Chi-square revealed sig n ifican t differen ce in engorged breasts between unmarried adolescent m others and m arried adolescent mothers [c2 (3.84) 6.30, p < .01].A significant difference in cracked nipples was also found betw een unm arried and m arried adolescent mothers, [c2 (3.84) = 4.12, p< .04],Non significant resu lts w ere found in postpartum hemorrhage, hypertension with systolic blood pressure of more than 140 mm Hg and diastolic pressure of more than 90 mm Hg, infected episiotomy and urinary retention.None of the adolescent mothers responded to the rest of the eight items on the scale.The results are presented on Table7.
Birth weight of infants in this sample was measure in grams (gm.

Discussions
The importance of the findings of this study lies in the provision of information on the impact of pregnancy on the health of adolescent mothers and their infants in the lowlands o f Lesotho.Nurses, policy makers, community leaders, and o th er p ro fessio n als need to work co llab o rativ e ly in providing com prehensive health program m es exclusively for adolescents and their infants.Appropriate programmes can only be provided if the needs o f the groups have been established.This study provides the baseline information that is needed in the provision o f such programmes.

Perceived Stress
The tw o groups o f m others had significantly higher stress levels than never-pregnant adolescents.Because this was the first study on perceived stress among adolescent m others in L esotho, no d eterm in atio n on the relationships among variables can be proposed.Both groups o f unmarried adolescent mothers and married adolescent mothers obtained high scores on the FOPQ, with non-significant differences between the two groups.Perhaps age and culture influenced the higher stress levels in this study.Adolescent m others may be finding it difficult to cope with the demands o f growing up, and having to deal with the pregnancy and parenting sim ultaneously.High stress levels among married adolescent mothers were unexpected, since pregnancy in married adolescents is cultu rally accepted.Perhaps demands of extended families outweigh the help that the mothers get from relatives and friends.

Maternal and Infant Health Outcomes
Adolescent mothers and infants that participated in this study were generally healthy.O nly a few m others had postpartum com plications.
It is noteworthy that adolescent mothers had more complications involving the breasts and the nipples.The mother has to take an active role in the prevention for these two complications.Even before the infant is bom, the mother has to take care o f the breasts and ensure that the nipples are soft and supple.But since adolescent mothers tend to attend fewer antenatal clinic visits than older women (Amini, Catalano, Dieker & Mann, 1996: 668), adolescent mothers in this study may have had a few or no lessons on breast care.The infants o f both unm arried and married mothers were generally healthy.Both groups o f infants w ere o f appropriate weight for gestational age at birth.No significant differences in terms of birth weight and nutritional status were found between the two groups of infants.The findings of the study support the findings o f earlier investigators who observed that older adolescent mothers have better maternal and infant health outcom es than younger adolescent mothers do.Therefore, indicating the need to separate these two groups when determining health outcomes (Amini et al" 1996:668;Naeye, 1981:32 No significant differences were found in immunization status between the infants o f unmarried and infants o f married mothers.The majority of infants had the expected number of doses and types of immunizations at 6 weeks post birth.One lim itatio n o f this study is that immunization status was observed at 6 w eeks post birth only.In order to contribute meaningful results, infants' im m unization status needs to be observed over a long period o f time.More longitudinal studies need to be done in this area in Lesotho.

Implications for Nursing Practice
Nurses are in an ideal position to reduce, stress, among pregnant and parenting adolescent, since nurses have more contact with these groups than any other health p ro fessio n als.N urses can potentially help these adolescents in a variety o f ways.They need to find out the causes o f these high stress levels among these groups, and help these adolescents to find solutions to their problems.Because pregnancy among unmarried adolescents has social stigma, nurses can potentially reduce some of the stress, by organizing the maternal child health services, so that adolescents have com prehensive health care programmes exclusively for adolescents and their infants.The adolescents may feel more comfortable in discussing their problem with their own colleagues, rather than discussing these problems in the presence of older women.N urses need to educate adolescent mothers and mothers to be about selfcare, including breast care.With the pandemic of HI V/AIDS and a number of mothers deciding not to breast feed in order to prevent mother transmission of the virus, m ore m others will need assistance with breast care.B reast feeding in public is culturally acceptable in Lesotho and in most African countries, and women generally practice this.However, it may be too embarrassing for the adolescent mother, who may not want the public to know that she has a baby.For this reason, those that choose to breast feed should be supported.The infants of both groups of mothers had very few health problems, and the majority of infants had the appropriate type and num ber o f doses o f im m unizations.C onsiderin g that immunizations are free in Lesotho, nurses should encourage every mother to take her infant to the clinic for immunization at the appropriate times, following the immunization schedule in the infant's health booklet (Bukana).

Implications for Research
This study provides baseline information on perceived stress, and health outcomes of the mother and her infant.Further research is needed in this area to determ ine relationships am ong the variables.In addition, studies using qualitative methods should be done in order to determine the reasons for breast problems among unmarried adolescent m others, and also to determ ine the difficulties these mothers my be facing due to pregnancy and parenting.Longitudinal studies should be done in order to produce meaning information on immunization and infant nutrition.Over a longer period of time, the mother would have had more discretion o f whether to bring her infant to the health center for immunization or not.The infant would have been weaned from the breast, thus exposing the infant to more chances of malnutrition, depending on the mother's know ledge and financial situation.Based on this information, nurses will potentially plan and implement effective program s for infants o f adolescent mothers.The Ministry of Health in Lesotho needs to allocate more funds for research among adolescent mothers and their infants in order to increase nursing knowledge in this area.

Implications for Policy
Adolescent pregnancy is a challenge to most countries of the world.Different cou n tries approach this problem differently depending on cultural beliefs and economy.The findings of this study have important policy implications in a number o f areas, including education, economy and health.

Education
Both groups of unmarried and married adolescent mothers were older and had lower levels of education than the group o f their never-pregnant counterparts.These findings support earlier findings indicating that adolescent pregnancy limits educational opportunities (Mturi & Moerane, 2(X) 1:260; William, & Mavundla T.R., (1999).Policy makers can potentially use the fin dings o f this study to implement programmes that will help adolescents to postpone pregnancy and to continue with their education.Ageappropriate information on sexuality needs to be introduced early in life and continued throughout high school.A dolescents who becom e pregnant should not be dismissed from school without alternative programmes.Lesotho needs to develop alternative high school programmes so that these adolescents can complete their high school education and potentially lead productive lives.

Economy
Policy makers in Lesotho need to develop and implement policies that will not only keep adolescents in school to complete their high school education, but also help them become self-reliant through skills development programmes.Adolescent pregnancy not only drains resources from relatives and friends, but also drains the economy of the country as whole.For example, health care is subsidized by the government in Lesotho.Services such as immunization are free.Therefore, early childbearing creates more financial burden on the country.
Health Cocky ( 1997:32) suggests that adolescent pregnancy should be viewed as a public health problem rather than a moral issue.This investigator further indicates that industrialized countries such as the United Kingdom and Japan that have used this approach have managed to reduce adolescent pregnancy.Perhaps Lesotho should follow this approach in order to reduce adolescent pregnancy and its negative impact on the health of adolescents.

Limitations
Two methodological limitations were identified in this study.Firstly, the sample in this study was a convenience sample from the lowlands in Lesotho.Therefore, the results may not be generalized to the entire population, including adolescents in the mountainous areas.Secondly, this was a cross-sectional study.Variables such as im m unization status and nutritional status need to be observed over time in order to contribute more meaningful results.However, despite these m ethodological problems, this study provides useful information on perceived stress, and health outcomes among adolescent mothers and their infants in Lesotho.

Summary
Findings o f this study indicate that pregnancy and p arenting am ong adolescents have a negative impact on the health of adolescent mothers in the low lands o f Lesotho.Faced with developmental tasks o f adolescence, teenage mothers find pregnancy and parenting to be stressfu l events.S eem ingly not having a baby and continuing with the one's education lead to health benefits for these adolescents.Never-pregnant adolescents had better health outcomes than the two groups of unm arried and m arried adolescent mothers including the lowest levels of stress.Infants o f both unmarried and married mothers had similar results in terms o f birth weight, nutritional status, and immunization status.

Recommendations
It is recommended that a larger study, in which the sample includes adolescents from the mountainous areas, be done in order to generalize the findings to the entire population in Lesotho.It is also recommended that longitudinal studies w hich test nutritio n al status and immunization status of infants be done.These longitudinal studies will help nurses to identify infants that are at more risk of malnutrition or o f not getting all their required im m unizations at the appropriate time.
Fin. Sup.*= financial support Income* = % is based on the numbers of those who knew their parents' income.LEC* = Lesotho Evangelical Church SDA* = Seventh Day Adventist Church adolescents.The majority (N = 24) 37.5%, of unmarried adolescent mothers and the majority, (N = 23) 35.9%, of married adolescent mothers had seven years of schooling or less.Every adolescent girlin this group was in the 1 l'h grade.The difference in education was the result of attempting to match the ages of single never-pregnant adolescents with those o f parenting adolescents.Every adolescent in the study was a Mosotho, except one never-pregnant adolescent who reported to be Xhosa.Most, (N = 33) 5 1.6%, of married adolescent mothers reported to be living with their husbands.

Table 1 A summary of the instruments and reliability coefficients Concept Measurement Level of measurement & Possible Scores Cronbach's Alpha From the Literature Cronbach's Alpha From Study Sample
members.The time frame was modified from the past one month in the original scale to the past 6 months in order to cover the pregnancy period.The FOPQ measures concerns specifically related to pregnancy and delivery.The postpartum Complication Checklist was used to m easure postpartum com plications.

Table 3 Descriptive statistics: Infants of unmarried adolescent mothers (n = 64) and infants of married adolescent mothers (N = 64) Variable Infants of Unmarried Mothers Infant of Married Mothers
never preg n an t ad o lescen ts were supported by their parents.Both groups o f m others cam e from low -incom e families.Some adolescent mothers did not know their su p p orter's income.However, of those who had information on their supporter's income, (N = 31) well.Every adolescent in this study reported to be a C hristian.The ch a rac te ristic s o f the groups o f adolescents are presented in Table2.